Advertisement

Frequency of Renal Artery Stenosis After Renal Denervation in Patients With Resistant Arterial Hypertension

      Catheter-based ablation of nerves in the adventitia of renal arteries (renal artery denervation [RAD]) using radiofrequency energy can reduce blood pressure (BP) in patients with resistant arterial hypertension (RAH). Occurrence of renal artery stenosis after RAD is still an important concern. We systematically investigated the renal artery anatomy using magnetic resonance imaging (MRI) or computed tomography (CT) angiography in a consecutive series of patients 6 months after RAD. Patients with RAH were treated by RAD after exclusion of secondary causes of hypertension. RAH was defined by a mean systolic office BP >160 mm Hg. Renal artery imaging was performed 6 months after RAD by MRI angiography. In case of any contraindication for MRI, a CT angiography was performed. The primary end point was the incidence of significant renal artery stenosis (≥70% lumen diameter reduction). RAD was performed in 76 patients, and evaluation of renal artery anatomy by MRI (n = 66; 87%) or CT angiography (n = 10; 13%) was performed in all patients 6 months after RAD. We found no renal artery stenosis but 2 cases of new nonsignificant stenosis (50% TO 69% lumen diameter reduction). In responders, mean systolic office BP reduction was −30 mm Hg (p <0.001) and mean systolic 24-hour BP reduction was −18 mm Hg (p <0.001). In conclusion, the incidence of significant renal artery stenosis 6 months after RAD seems to be very low. However, late-onset development of nonsignificant renal artery narrowing cannot be excluded in some patients and should be anticipated in the case of RAH relapse or worsening of renal function after successful RAD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parati G.
        • Esler M.
        The human sympathetic nervous system: its relevance in hypertension and heart failure.
        Eur Heart J. 2012; 33: 1058-1066
        • Smith P.A.
        • Graham L.N.
        • Mackintosh A.F.
        • Stoker J.B.
        • Mary D.A.
        Relationship between central sympathetic activity and stages of human hypertension.
        Am J Hypertens. 2004; 17: 217-222
        • Grassi G.
        Sympathetic neural activity in hypertension and related diseases.
        Am J Hypertens. 2010; 23: 1052-1060
        • Krum H.
        • Schlaich M.
        • Whitbourn R.
        • Sobotka P.A.
        • Sadowski J.
        • Bartus K.
        • Kapelak B.
        • Walton A.
        • Sievert H.
        • Thambar S.
        • Abraham W.T.
        • Esler M.
        Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study.
        Lancet. 2009; 373: 1275-1281
        • Esler M.
        • Krum H.
        • Sobotka P.
        • Schaich M.P.
        • Schmieder R.E.
        • Böhm M.
        • Symplicity HTN-2 Investigators
        Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 trial): a randomized controlled trial.
        Lancet. 2010; 376: 1903-1909
        • Esler M.D.
        • Krum H.
        • Schlaich M.
        • Schmieder R.E.
        • Böhm M.
        • Sobotka P.A.
        • Symplicity HTN-2 Investigators
        Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial.
        Circulation. 2012; 126: 2976-2982
        • Lambert T.
        • Schützenberger W.
        • Steiwender C.
        Renal denervation in the treatment of resistant arterial hypertension.
        Wien Med Wochenschr. 2014; 164: 515-518
        • Lambert T.
        • Blessberger H.
        • Gammer V.
        • Nahler A.
        • Grund M.
        • Kerschner K.
        • Buchmayr G.
        • Saleh K.
        • Kammler J.
        • Steinwender C.
        Effects of renal denervation on ambulatory blood pressure measurements in patients with resistant arterial hypertension.
        Clin Cardiol. 2014; 37: 307-311
        • Lambert T.
        • Gammer V.
        • Nahler A.
        • Blessberger H.
        • Kammler J.
        • Grund M.
        • Kerschner K.
        • Buchmayr G.
        • Saleh K.
        • Kypta A.
        • Hönig S.
        • Wichert-Schmitt B.
        • Schwarz S.
        • Sihorsch K.
        • Reiter C.
        • Steinwender C.
        Individual-patient visit-by-visit office and ambulatory blood pressure measurements over 24 months in patients undergoing renal denervation for hypertension.
        Int J Cardiol. 2014; 181: 96-101
        • Doumas M.
        • Faselis C.
        • Papademetriou V.
        Renal sympathetic denervation and systemic hypertension.
        Am J Cardiol. 2010; 105: 570-576
        • Pancholy S.B.
        • Shantha G.P.S.
        • Patel T.M.
        • Sobotka P.A.
        • Kandzari D.E.
        Meta-analysis of the effect of renal denervation on blood pressure and pulse pressure in patients with resistant systemic hypertension.
        Am J Cardiol. 2014; 114: 856-861
        • Bhatt D.L.
        • Kandzari D.E.
        • O'Neill W.W.
        • D'Agostino R.
        • Flack J.M.
        • Katzen B.T.
        • Leon M.B.
        • Liu M.
        • Mauri L.
        • Negoita M.
        • Cohen S.A.
        • Oparil S.
        • Rocha-Singh K.
        • Townsend R.R.
        • Bakris G.L.
        A controlled trial of renal denervation for resistant hypertension.
        N Engl J Med. 2014; 370: 1393-1401
        • Rippy M.K.
        • Zarins D.
        • Barman N.C.
        • Wu A.
        • Duncan K.L.
        • Zarins C.K.
        Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety.
        Clin Res Cardiol. 2011; 100: 1095-1101
        • Vonend O.
        • Antoch G.
        • Rump L.C.
        • Blondin D.
        Secondary rise in blood pressure after renal denervation.
        Lancet. 2012; 380: 778
        • Kaltenbach B.
        • Id D.
        • Franke J.C.
        • Sievert H.
        • Hennersorf M.
        • Maier J.
        • Bertog S.
        Renal artery stenosis after renal sympathetic denervation.
        J Am Coll Cardiol. 2012; 60: 2694-2695
        • Bhamra-Ariza P.
        • Rao S.
        • Muller D.W.
        Renal artery stenosis following renal percutaneous denervation.
        Catheter Cardiovasc Interv. 2014; 7: 1180-1183
        • Lambert T.
        • Blessberger H.
        • Grund M.
        • Steinwender C.
        Late renal artery stenosis after percutaneous renal denervation.
        J Cardiovasc Med (Hagerstown). 2014;
        • Jaen Aguila F.
        • Mediavilla Garcia J.D.
        • Molina Navarro E.
        • Vargas Hitos J.A.
        • Fernandez-Torres C.
        Bilateral renal artery stenosis after renal denervation.
        Hypertension. 2014; 63: e126-e127
        • Mancia G.
        • Fagard R.
        • Narkiewicz K.
        • Redon J.
        • Zanchetti A.
        • Böhm M.
        • Christiaens T.
        • Cifkova R.
        • De Backer G.
        • Dominiczak A.
        • Galderisi M.
        • Grobbee D.E.
        • Jaarsma T.
        • Kirchhof P.
        • Kjeldsen S.E.
        • Laurent S.
        • Manolis A.J.
        • Nilsson P.M.
        • Ruilope L.M.
        • Schmieder R.E.
        • Sirnes P.A.
        • Sleight P.
        • Viigimaa M.
        • Waeber B.
        • Zannad F.
        The Task Force Members, The Task Force for the Management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC): 2013 ESH/ESC Guidelines for the management of arterial hypertension.
        J Hypertens. 2013; 31: 1281-1357
        • Ott C.
        • Schneider M.
        • Schmieder R.
        Ruling out secondary causes of hypertension.
        EuroIntervention. 2013; 9: R21-R28
        • Persu A.
        • Renkin J.
        • Asayama K.
        • O'Brien E.
        • Staessen J.A.
        Renal denervation in treatment-resistant hypertension: the need for restraint and more and better evidence.
        Exp Rev Cardiovasc Ther. 2013; 11: 739-749
        • Zeller T.
        • Rastan A.
        • Macharzina R.
        • Noory E.
        Challenging anatomy, how to treat or not to treat?.
        EuroIntervention. 2013; 9: R67-R74
        • DiBona G.F.
        • Esler M.
        Translational medicine: the antihypertensive effect of renal denervation.
        Am J Physiol Regul Integr Comp Physiol. 2010; 298: R245-R253
        • Mahfoud F.
        • Bhatt D.L.
        Catheter-based renal denervation: the black box procedure.
        J Am Coll Card Cardiovasc Interv. 2013; 6: 1092-1094
        • Lüscher T.F.
        • Mahfoud F.
        Renal nerve ablation after Symplicity HTN-3: confused at a higher level?.
        Eur Heart J. 2014; 35: 1706-1711
        • Mahfoud F.
        • Edelman E.R.
        • Böhm M.
        Catheter-based renal denervation is no simple matter—lessons to be learned from our anatomy.
        J Am Coll Cardiol. 2014; 64: 644-646